微针刀松解术结合整脊调神推拿法治疗颈性眩晕的临床及相关文献研究

发布时间：2018-03-09 03:32

本文选题：颈性眩晕　切入点：整脊调神推拿法　出处：《山东中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的:通过对推拿和针刀治疗颈性眩晕的临床研究文献进行计量统计,并对提取内容进行分析,为本课题设计的科学性和规范性以及临床研究的可行性与创新性提供文献依据。同时,通过观察对比临床研究中治疗组与对照组治疗前后的各项观察指标的变化,从患者主观感觉和客观检测指标两方面分别分析评价两组临床疗效,并就发病机制、诊疗机理及观察指标设定依据等方面做相关探讨。以期减少颈性眩晕临床诊疗中的盲目性,提高诊断正确率,制定出一个操作安全、起效快、疗效持久的颈性眩晕规范化治疗方案。方法:采用文献调研及内容分析法对相关临床研究文献进行统计,并参考结果设定课题的相关研究标准与观察指标,采用随机、对照的设计方法,把纳入的60例颈性眩晕患者平均分为微针刀松解结合整脊调神推拿组(治疗组)和常规针刺结合整脊调神推拿组(对照组)。均治疗2疗程后观察并比较分析两组在生活质量评定量表(SL-36)、颈性眩晕症状与功能评估量表、症状自评量表(SCL90)评分的变化;测量颈椎X线片中颈椎曲度、经颅多普勒超声(TCD)中椎-基底动脉血流速度以及脑干听觉诱发电位(BAEP)波潜伏期、波间期的数值变化。并采用SPSS数据处理软件对结果进行统计处理分析。结果:文献研究中,统计分析了301篇推拿相关文献及84篇针刀相关文献的各项提取内容。临床研究中,无不良反应发生,且两组患者经治疗后,治疗组临床总有效率90.00%,对照组临床总有效率76.67%。各项观察指标经统计学分析可发现,两组患者主观感受指标中的SL-36与SCL90评分仅部分项目治疗前后评分有显著性差异(P0.05),治疗组改善优于对照组。治疗前后的颈性眩晕症状与功能评估量表中各项评分均有显著性差异(P0.05),治疗组改善优于对照组,而治疗后与疗程结束1月后随访相比,各项评分无明显差异(P0.05)。客观检测指标中,两组治疗前后X线中的颈椎曲度指数与TCD中椎-基底动脉的血流速度的变化均有显著性差异(P0.05),治疗组改善优于对照组。而两组患者的BEAP治疗前后变化并不明显,仅在PLⅤ一项中有显著性差异(P0.05),治疗组优于对照组。结论:通过临床与相关文献研究可发现,本课题的设计具有一定的可行性与创新性,两组治疗方法均安全有效,且治疗组临床总疗效与各项评价指标改善情况均优于对照组。对于患者主观感受指标的观测可发现,经过治疗,两组患者在生活质量与心理健康水平方面有部分改善;在临床症状与体征方面的治疗效果较显著,且疗效较持久。在客观检测指标方面,两组治疗方法均可对患者的椎-基底动脉血流速度起到积极影响,有效调整患者颈椎整体曲度,说明TCD与颈椎X线均可作为颈性眩晕患者较敏感的临床诊疗指标;但患者对于BEAP的检测结果并不敏感,无法获取有效观测结果。本课题为颈性眩晕的临床治疗提供了更好的方案,具有一定的临床价值和理论意义。
[Abstract]:Objective: through the clinical research literature on statistical manipulation and acupotomologic therapy of cervical vertigo, and the extraction of content analysis, provide literature basis for the scientific and normative design of the subject and the clinical research on the feasibility and innovation. At the same time, by observing the changes of observation index of clinical research in the treatment group and the ratio of the control group before and after treatment, from the two aspects of the patient's subjective feeling and objective indexes analysis and evaluation of the clinical efficacy of the two groups, and the pathogenesis, diagnosis and treatment mechanism and observation index set on the basis of making relevant discussion. In order to reduce the blindness of clinical diagnosis and treatment of cervical vertigo, improve the rate of correct diagnosis, develop a safe operation, rapid onset of cervical vertigo lasting effect of specification treatment. Methods: the clinical research literature statistics by literature research and content analysis, and reference The test results of standard setting research and observation index, using a randomized control design method, 60 cases of cervical vertigo were divided into the average micro Acupotomy combined with chiropractic massage metality group (treatment group) and conventional acupuncture and chiropractic massage metality group (control group) were treated. After 2 courses of observation and comparative analysis of two groups in the quality of life scale (SL-36), cervical vertigo symptoms and functional assessment scale, symptom checklist (SCL90) score changes; measurement of the cervical spine radiographs of cervical curvature, transcranial Doppler (TCD) in vertebral basilar artery blood flow velocity and brainstem auditory evoked potential (BAEP) latency, numerical variation of wave intervals. And using SPSS data processing software to statistical analysis of the results of treatment. Results: literature research, statistical analysis of the 301 literature and 84 acupuncture massage literature extract content Clinical study, no adverse reaction, and the two groups of patients after treatment, the total effective rate of treatment group 90%, control group total clinical efficiency indexes of 76.67%. can be found by statistical analysis, two groups of patients before and after subjective indexes of SL-36 and SCL90 was only part of the project treatment score had significant difference (P0.05), the treatment group was better than the control group. Both the scale score of cervical vertigo symptoms and functional assessment before and after treatment with significant difference (P0.05), the treatment group was better than the control group, and after treatment and follow-up after the end of treatment compared to the January, there were no significant differences (P0.05). Objective indexes in the change of blood flow velocity were cervical curvature index of X-ray and TCD of vertebrobasilar artery were significant differences between the two groups before and after treatment (P0.05), the treatment group was better than the control group. BEAP of two groups of patients before and after treatment The change is not obvious, only in PL v a significant difference (P0.05), the treatment group than the control group. Conclusion: the clinical and research literature can be found, it is feasible and innovative design of this project, two groups of treatment methods are safe and effective, and the treatment group the total clinical efficacy evaluation index with the improvement of the situation was better than the control group. The observation indexes of patients with subjective feelings can be found, after treatment, two groups of patients with partial improvement in the quality of life and mental health; the clinical symptoms and signs of the treatment effect is significant, and the effect is lasting. In the objective indexes, blood flow velocity can be two groups of treatment on patients with vertebrobasilar plays a positive effect, effectively adjust the patients with cervical curvature TCD and cervical X-ray can be used as a sensitive index for clinical diagnosis and treatment of patients with cervical vertigo; but Patients are not sensitive to the results of BEAP detection, and can not get effective observation results. This project provides a better solution for clinical treatment of cervical vertigo, which has certain clinical value and theoretical significance.

【学位授予单位】：山东中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.9

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